The first challenge for the University of Wyoming medical and service team that recently came and visited the small community of Agua Salada (translated “Salt Water” – really interesting since you would need to cross all of El Salvador to find saltwater) is getting them there. The 22 participants (20 women and 2 men) plus six translators packed into the bus in La Esperanza to begin their trek. It’s all downhill, not very far really, but taking over two hours. Even though the highway is being rebuilt and paved, you cannot travel fast along the treacherous curves. This is called the “highway,” and at first everyone laughs at that term until they experience driving on what is not the highway. We arrive at the nice, modern-looking, clinic in Concepción. Everyone piles off the bus. They think they’ve arrived and there are expressions of relief. Their expressions droop, however, when they realize their bags are being packed into the beds of pick-up trucks. The bus won’t go where you are going. You’re not there yet!

Relaxing at the Clinic

The luggage is delivered first with as many people as can fit into the cabs of the trucks. An hour later, the trucks return and they get packed up with people: seven or eight in the beds and four or five into the cabs. I’m driving one. For safety’s sake I tell those in the bed to sit down or hold on. They laugh at me and I crack a knowing smile. We turn off the ‘highway’ to begin the three to five mile per hour crawl to Aqua Salada. Over the ruts and rocks the truck launches them off their feet or bounces them off their behinds. I hear their screams and hoopla. Someone from the backseat of the cab says they want to be in the bed when we return next week. It’s better than the best amusement park ride. We come to the river. Someone from the bed yells out, “Where’s the bridge?” just as I enter into the water with the truck. The water is a little high for the dry season. “This is awesome!”

Folks gathered at the clinic

We arrive at the Agua Salada clinic facility. They grab their suitcases and gear. Most definitely exhausted, their minds racing with all the newness they are taking in, they now need to set up their tents and sleeping bags. The clinic is really nice, well designed, but not really equipped for over thirty people. They will be tripping over one another all week. This makes boot camp look like a five-star luxury hotel. But, they are well received by the people living in this forsaken and forgotten territory. What the team will put up with for a week is nothing as compared to what the people who live here endure every day.

But, that’s why they’ve come. The Agua Salada residents and those from the surrounding small villages are always enthusiastic and grateful for the arrival of Wyoming. Most wouldn’t be able to find the state on a US map, but they well know the hearts and souls of those who have journeyed to visit them. There is a sense of celebration among the community that finds varied expressions during the week. Over five-hundred persons will visit the clinic. Many will see Larry the dentist who has been coming since before the clinic was built. Linda, a nurse practitioner now retired from the University, leading the team, knows everyone. Indeed she’s watched many grow up. They’ll have a special luncheon for the parteras (midwives), and all week long the children will be playing soccer with the gringos. It feels like the circus has come to town. I take that back. It’s more like a homecoming. It is a time for catching up, a time to become reacquainted, and a time to really enjoy a very special, perhaps even sacred, friendship. Laura and I will meet up with them at the school scholarship festivities.

Linda with a scholarship student

We take going to school for granted in the US. But for the people in Aqua Salada and the surrounding area, even the small costs associated with public school – backpacks, notebooks, uniforms, shoes (yes shoes), and other materials – can be overwhelming for a family without any income. Wyoming has responded well to the need, setting up a scholarship program to fund these families. It’s not blind charity. It’s a covenant where the students and the families commit to community service and the maintenance of good grades. This makes the relationship an honest one — one in which the travelers from Wyoming and the residents of Agua Salada find mutual respect and commitment. This program is for the children attending what is referred to as ciclo comun – seventh, eighth, and ninth grade. Very few will go beyond those grades because it is just too difficult for the families. They would have to travel to one of the municipalities to go to High School and earn a degree. The transportation cost is prohibitive. Wyoming is now also responding to this need as well. It is a larger commitment on the part of Wyoming, but one they are pleased to be able to make. The most promising students, the ones who have a burning desire to be educated, will now be able to live their dream and receive a high school education. They will become honored in their families and their communities, and Wyoming will have a legacy of noble value.

All the scholarship students, their families, and the team from Wyoming gathered in the church for the ceremonies. Records were turned in, contracts were signed, and the scholarships administered. Some of the students spoke of the incredible gift of education and expressed their gratitude to Wyoming for the trust that had been given to them. I watched an older man’s hand sign his commitment for his granddaughter. His hand was shaking, but his smile was one of profound dignity. I thought I saw a small tear in his eye as he placed an “X” on the signature line. Perhaps he had missed the opportunity to read and write, but his granddaughter would not.

Back across the bumpy road and the river the service team would travel. In another day they would be thousands of miles away, comfortable in soft beds, their privacy secured. It will be a long time, however, before they forget their experience among the people of Agua Salada. The people of Agua Salada will, of course, never forget. They will be ready to welcome them back when they return.

Laura and I are in our fourth year in Honduras and have been with Shoulder to Shoulder just over two. We’ve seen many changes in that short period of time in Honduras, on the Frontera of Intibucá, and even in Shoulder to Shoulder. We look at our job as trying to steer those changes in such a way that they help the people of the Frontera to better the circumstances of their lives, and ultimately find clear paths to the healthy development of their communities. We do not do this on our own. There are a lot of partners that share in that vision and mission, shouldering the movement toward development. A substantial part of our job then is to keep our partners excited and committed, while at the same time draw others into the mission.

Scene from Pinares Clinic

One partner that’s been with us for a very long time is Virginia Commonwealth University (VCU). They have built strong relationships with the people living in and around the small community of Pinares. They built the clinic there and have been visiting the community three times a year for a very long time. Dr. Thomas Ball, recently here to continue the provision of much needed medical care, told us he’s been coming to Pinares for the last ten years. He’s seen some changes too, many more than Laura and I. One for which he is quite pleased is that the road to Pinares is now entirely paved, a hopeful symbol of the healthy development that VCU and StS hope to see continue for Pinares.

The thing that has always impressed me about VCU in its ongoing relationship with the community of Pinares is the stability and sensitivity of commitment. VCU has become a part of the family of Pinares, their home town doctors if you will. A few years ago, I asked a leader why they did not build nicer dormitories for the brigade teams that come regularly. They built a state-of-the-art clinic, but they sleep in tents at a well-worn schoolhouse down the road from the clinic. The answer was that they wanted to live as the people lived while they visited them, and that they preferred to spend their resources on the provision of direct service. That pretty much sums up the sense of commitment in relationship that VCU has invested in the people of Pinares.

Dr. Tommy Ball fistpumping young patient

Even so, VCU has recognized that their mission is not one they can claim as exclusively their own. They have need to call others to share in that mission as it is a long journey of service. They have found a committed partner in Fairfax Family Practice Centers and have founded an NGO, SAGE, to maintain focus and resources in the Pinares communities. Their mission is ongoing because they have been open to the inevitable changes time brings and the need to draw others into the mission.

After Lunch

I saw this in the most recent visit of VCU. The presence and familiarity of VCU as part of the Pinares community is the root for the service that is delivered during the brigade experience. Dr. Ball, with the strength of ten years experience, planned for this November brigade. He thought it would be a very modest and small brigade as it has become harder and harder to find the medical students, and providers to invest in such an experience. But with the rootedness that is the sustained relationship of integrity between VCU and Pinares, new branches have sprung forth. Jamaica Hospital Medical Center had contacted us looking for a brigade experience for residents. We hooked them up with VCU. A young man having just finished high school also contacted us looking for a brigade experience. We hooked him up with VCU. Dr. Ball wanted to bring a pharmacist with the brigade. A young pharmacist from a local CVS answered the call. The small brigade of two physicians and three medical students doubled itself with the addition of four providers from Jamaica Hospital Medical Center, an enthusiastic volunteer, and the CVS pharmacist. The old, the stable, the committed found a new thrust of energy in those willing to join in the mission.

Growth, movement, progress, and development are rooted in committed relationships. Those relationships bring about a sense of familiarity, the comfort of what we like to define as home. VCU has certainly found a home at Pinares among the people they have so faithfully served for years. But years and time imply change and growth. In development there is no place for complacency. We need to search out the new to enhance and enliven our relationships. This road to development is well paved.

Over the course of twenty-six years, thousands of individuals and hundreds of professional and academic associations have shouldered the mission of improving the quality of life on the Frontera by visiting Honduras on service trips. They have paved the way for the ongoing provision of quality health care and established the infrastructure to support that ongoing care. Through dedication and commitment, through the sharing of expertise and knowledge, these associations and individuals have uprooted the embedded poverty that denied people basic health care and planted systems of sustainable empowerment. People live longer, healthier, more productive and fulfilling lives in strong communities. These individuals and groups will continue to visit and support and grow this sustainable system of quality health care delivery. Shoulder to Shoulder will support their dedication, commitment, and service.

Shoulder to Shoulder has become an expert in receiving medical professionals and students, sending them out to treat the people, and coordinating that service in relationship to our ongoing heath care service delivery. We’ve done it for so long, it’s become second nature. However, we are yet inexperienced when it comes to receiving and utilizing groups coming specifically to assist us in our evolving mission of education.

Papa Grande with the kids

Laura and I nervously awaited the arrival of Genesee Valley Presbytery who came to visit us in Camasca. Though they came as a service group, they had no medical expertise and had no intention of providing health care. They came to exclusively work at our bilingual school. Laura and I know how to manage medical teams. Also, the medical teams have an inherent focus on their service in providing health care. But what would this group do, and how would we organize their efforts? In part it was a construction brigade to establish a rain water collection system at the school. In part it was a school brigade where they would offer games and exercises with the children. In part it was a resource brigade to stock and organize the shelves of our library. Their focus was disparate as were their personalities. In speaking to them on their first night in Honduras, I realized they were all different individuals and no one principle gave them a coherent organization. Some were here because they liked construction, some because they enjoyed singing and celebrating with the kids, and still others wanted to catalogue books. How would I do this? How would I herd these cats? My anxiety rose.

Constructing

It was needless anxiety. I soon realized that there was indeed a common organizing principle to their service mission. It wasn’t a professional principle, though it was clear that the contractors, engineers, musicians, and teachers knew their stuff. It wasn’t so much a drive to realize specific objectives, though they accomplished incredible things. The organizing principle was much more profound than this. They all shared a generous spirit, a willingness to serve no matter what need was encountered, a singular respect for the people they met, and a driving desire to come to know in a meaningful way the children of our school and the people of Camasca. This was what we might call charm and grace. They had loads of it, and in six days they found a place of welcome in the hearts of our children and the people of Camasca.

I could simply focus here on what they accomplished because it impressed me beyond my expectations. They built a quality water collection system in about two days, making me scramble to find additional construction projects to keep them busy. They added six hundred books to our library, and organized a eclectic mess into an efficient store of knowledge and literature. They enlivened and enriched our students with song and spirit each morning. They visited other area schools, gifting them with their presence as well as with books and clothes. This success would certainly have been sufficient, but there was more.

Chris and Jan in classroom

They did it all and had tremendous fun doing it.

“Papa Grande,” aka Adam, played his guitar, sang his songs, and corralled the smiles of our children.

“Gopher,” aka Tony, busied himself in digging holes.

Andy was forever ready with the right tool for the job.

Jeff, the still, but deep waters, was always ready to help.

Bill drew up plans and designs.

Chris may have found a new vocation as a librarian coding books and stacking shelves.

Whitney mastered the troops.

Lori provided for all needs from a bottomless purse.

Jan articulated the sacred privilege of reading.

And as all this business went on, we found time to barb one another with groaning puns. Pat provided the ultimate symbol for this in carrying “Donkey Hotey” back to the states.

We followed Dan’s challenge to us all by “super-sizing” our generosity and realizing the super-sized response in the appreciative embrace of the people of Camasca.

Whitney and Chris

What wondrous things Shoulder to Shoulder has achieved over the course of twenty-five years in the dedication and commitment of professional service teams. True enough. I am certain that just as we have established a sustainable system of quality health care because of the generous service of medical mission teams, so too we will establish quality, sustainable education on the Frontera as we develop relationships with groups and individuals to shoulder this mission. It is always so impressive to see what we have built and accomplished. It is, however, so much more impressive when we find meaningful connections that bind us to the best of who we are. This is grace.

Laura and I at an earlier time in our Honduran experience used to frequently walk by a dental clinic. The dentist there was very friendly and would wave and say hello as we walked by. We’d sometimes see patients going in or coming out. We thought it a bit surreal, however, as many of these patients had very few teeth, and the ones they still had didn’t appear very healthy. One day, the dentist invited us into his clinic. There weren’t any instruments or materials, save for a torturous looking instrument that was obviously designed to yank teeth out. The “dentist,” of course, was not really a dentist, and the “clinic” was not really a clinic. Were we appalled? Well, yes and no.

According to developed world sensitivities, having had professional dental care all our lives, and having been well-trained since youth in the importance of regular brushing and flossing, we would look upon this “dentist” and his “clinic” as archaic and barbaric. Our first reaction might be to call the ADA and have this man’s opportunistic practice closed down. But, this is not a developed world we live in, and perhaps we need to look closer at the context. There is no real dental care here, no programs to teach dental hygiene, and the term ‘dental health’ is an oxymoron. Yet, there are dental issues. People have toothaches. Given such limited resources and options, given a societal consciousness of dental care as pre-professional by developed world standards, what choices really exist? Extractions are the best, if not only, response to bringing relief. There are few voices to cry out against it. In fact there are all sorts of dental brigades that come to Honduras. They’re generally not here to raise the societal consciousness of what constitutes dental health and hygiene. Nor are they here to equip Honduras with the tools and skills to institute systems of periodontal professional care. They are here to pull teeth. So how are these US dentists any better than our friendly “dentist” at his “clinic?” Who is mimicking who? And how would one really go about making dental health a legitimate, sustainable reality in Honduras?

The answer is simple really. All you need is a generation of time and patience, a gargantuan amount of money and resources, professional and technical expertise readily available and disposed to assist, and Hondurans generously taking on an onerous mission that runs opposed to societal structures and practices. Am I being facetious? Well, yes and no.

Jan and Larry Tepe have dedicated themselves to making dental health a legitimate, sustainable reality in Honduras, particularly in the Frontera, for decades. They have garnered and directed the time, money, resources, and professional and technical expertise necessary to reshape the societal consciousness of what dental health is in Honduras. They have given it all away to Hondurans in whom they can do no more than trust will carry on an onerous mission. What a tremendous investment! Has it made a difference?

I suspect when Jan and Larry first started coming to Santa Lucia and Concepción, they did a lot of extractions. Through the decades, they have developed teams of dentists, dental students, dental assistants and hygienists, and other professionals to share in their mission. They also invested in Honduran professionals and dentists to slowly come to an appreciation and sharing of their vision and mission, working shoulder to shoulder. Jan and Larry were recently here again with Beth Deyhle, dental assistant in August. I suspect their time here now was qualitatively different than was their first experiences.

Today, when they come they work alongside two professional competent dentists, Dr. Idalia Ramos in Concepción and Dr. Flor Amaya in Santa Lucia, who run private dental clinics offering care that parallels quality care in the US. For all the years of Jan and Larry’s commitment, Dr. Idalia and Dr. Flor worked as employees of Shoulder to Shoulder. This year, Shoulder to Shoulder enabled the transformation of US subsidized clinics to private, Honduran enterprises. Jan, Larry, and Beth were here to support their work and not to impose their superiority. They are assisting them in obtaining the resources and the competence to manage their practices, and offering them training in promoting their practices as viable and sustainable. Dr. Flor and Dr. Idalia are in turn changing the societal consciousness relative to what constitutes dental health and making it possible for all persons to gain access to quality dental care. The work is not done. Decades have already been committed and further decades will be necessary, but substantial change has already taken place and the foundation is laid for continuing the revolution.

“Open wide!” That’s a loaded phrase, isn’t it? We’ve all heard it, reclining somewhat stiffly back in that odd shaped chair, a bright light blinding us, a bib alligator clipped around our neck, with the masked, white-coated person hovering over us. And we are anxious to what will be found when we open wide and expose ourselves to sharp, probing instruments. But if we do not open wide, if someone doesn’t insist upon it, we see only the surface of things and our remedies for improvement are limited by what is never really looked at or examined. So, perhaps it is best to probe deeper, under the surface and into the cavities where the forces that shape and define us dwell. That does in fact seem to be the work of a dentist. Jan, Larry, and Beth visited our bilingual school while they were with us. Our bilingual school children have benefited from free dental care subsidized by Shoulder to Shoulder for years now. The children smiled for them when they visited; bright beaming smiles of health, well-being, and confidence. All this now because Jan and Larry were not willing to simply look upon the surface. Rather, as the good dentists that they are, they voiced their demand. Open wide!

Laura and I love living in Honduras; we couldn’t be happier. Still, the differences between us and Hondurans, culturally, linguistically, and even physically, are sometimes highlighted. They are mostly simple things to note and they don’t present challenges, but sometimes they can remind you that you are the odd person out in this society. The sense of time and efficiency in systems often sets me reeling, and sometimes railing, as no one ever meets my standard for punctuality. Similarly, my sense of personal space and privacy is frequently undermined as others barge in on my protected territories. High school and grade school students who we pass everyday huddled in groups of five to ten try out their limited English on us. They always wait until we pass when we’ll hear the brave one among them voice a “Gud Mowning.” We’ll turn and smile and respond, “Good Morning, How are you?” They all giggle and a few others will join in with more comically enunciated good mornings. This will continue back and forth four or five times dispersed with the adolescent giggles. It’s a recognition of our differences under a certain amount of insecurity, but also a transcendence that the differences are not insurmountable. There are so many other things that betray our difference. We dress different, eat different, stand and walk different. The cadence of our speech, the way we act and react, and the way we think all define us as the ones who come from some other world. We change as we live among the differences, sometimes adapting to new ways and sometimes not, but we will always be recognized as outside looking in.

MAHEC brigade members at the bilingual school

I was observing the medical service team MAHEC (Mountain Area Health Education Center, Asheville, North Carolina) a few weeks ago as they arrived in our little town of Camasca. They came as a twenty-three person team, working hard, visiting distant smaller communities every day, offering health care, delivering workshops in adolescent wellness at the High School, and sharing with the younger children at our bilingual school. Such a strong presence in such a small community like Camasca is hard to miss. Because Laura and I were particularly busy during the time they were here, we didn’t so much involve ourselves with their activities as watched them from a distance. I noticed them perhaps as a Honduran would. I saw them walking down the street from our street-side porch, dressed in their blue scrubs, walking very fast and purposely, presenting a different aura than I was accustomed to seeing on the street. They visited our porch most mornings as they could share our WiFi, check email, and post pictures on Facebook. I chuckled to myself to think of them as a herd of cattle of an unknown species that had wandered into our meadow. Still they were all well welcomed, honored by a sense of gratitude by their hosts. This, however, seemed somehow more than simply the thankfulness for their service. There was something noble about their presence that I could not define. I found myself thinking about this, trying to figure out exactly what it was, while they were here among us.

At the Camasca Health Center

On one of their days, they were visiting a small community called San Juan de Dios. The mayor of our town, Julio, had lent a few of his pick-up trucks to the brigade, and on this particular day, he himself had driven them to the clinic site. Laura and I weren’t with them, but it happened we were in the same area visiting families benefiting from our nutrition program, MANI. Driving on the main rock/dirt road, we saw a man in a dress shirt, cell phone to his ear, and shovel in his hand. As we approached him, we recognized him. It was Julio, the mayor. We stopped and talked. He was filling in the ruts on the road, channeled out by the hard driving rains. He was doing this in preparation for the return trip with the brigade members who would ride in the bed of his truck. It was a humble gesture of gratitude, commendable in and of itself, but again I felt there was something more profound in that visage. Again, I felt there was something of great value in these acts, in this interchange. It was elusive, but again the word “noble” came to my mind.

Laura and I were present at MAHEC’s going away celebration. There was cultural music and dance, a festive spirit. There were speeches in gratitude of MAHEC’s generosity and service. Then our mayor, Julio, got up to offer his words. He recalled some of the time he had spent with the MAHEC team while they were visiting the outlining communities and offering medical care. He began to recount a particular house visit and became emotionally choked up. They visited an older couple, very poor and very frail. They were most certainly coming to the end of life’s journey. There was nothing that the team could do for this couple, medically, but they shared their time with them, sat with them in their house by their bedside. It was this that moved Julio to tears, and he noted that next year when MAHEC would return, this old couple would likely not be with them. But for Julio this visit was of exceptional, incalculable, ineffable value.

Listening to Julio, I then knew what it was that I had been struggling to understand and define while MAHEC was visiting Camasca. Indeed, it was their presence that was noble. At first glance, this group of medical missioners from the US presented as so foreign. And so they are. But we can all get beyond that in deference to the reason they had come. In the second instance then, we can give them credit and gratitude, for the great and generous service that they offer. This, perhaps, would be enough. Yet Julio was moved by something else at a moment when no service was even possible. This is a moment when differences are neither noted nor have any meaning. This is a moment in which service — who is the giver and who is required to be grateful — is also of no import. This is a moment when all judgment is discarded, and what remains is the value of human caring. This is noble.